Food allergic diners balance on a knife edge

During a recent vacation, we met friends at a neighborhood hangout for dinner. As we walked in, I became worried — one sniff confirmed that a fish fry was taking place. After informing our server that I'm allergic to fish (also peanuts), she recommended the nachos.

When I lifted the first forkful, the chips were sizzling. I asked the server if, by any chance, the chips had been deep-fried in the same oil as the fish?

"Oops," she said, and whisked away the plate.

Oops, indeed. One bite and the evening could have become a medical crisis instead of a pleasant night out with friends. Ask any of the 15 million Americans with a food allergy, and chances are you will hear of a similar close call.

"Every time we go out to eat as a community with food allergies, we have to take very special precautions. More than anything else, we need to feel confident when we talk to a server or a chef that they understand cross-contamination and how to prevent it," says Paul Antico, founder of the website AllergyEats.com, designed to help consumers find allergy-aware restaurants.

Just to be clear, we're not talking about a food sensitivity or a lifestyle decision. With an allergic reaction, the immune system perceives a specific food protein as a threat and attacks it, producing excessive amounts of an antibody called immunoglobulin E (IgE). Allergies can develop at any point in life, although they tend to be more common and severe in children.

"Food sensitivities or intolerances can be uncomfortable, they can cause bothersome symptoms, but they are not typically life-threatening, and they are not due to a disorder of the immune system," explains Jessica R. Savage, an allergist and immunologist at Brigham and Women's Hospital in Boston.

"With a childhood milk allergy, we often advise not even going into a place like Starbucks, because the froth from the milk can be in the environment," says Savage, who teaches at Harvard Medical School.

The nonprofit advocacy group Food Allergy Research & Education, known as FARE, reports that every three minutes an acute allergic food reaction sends someone for emergency care, resulting in more than 175,000 such medical visits per year, far higher than once thought.

A common misconception is that a little bit of an allergen won't hurt. In fact, the body may react violently to even a trace amount. Because there is no cure for food allergies, avoiding allergens and quick treatment of symptoms is the only recourse. (Auto-injected epinephrine, such as an EpiPen, and antihistamines typically are the first line of defense, followed by emergency medical care.)

FARE recently teamed up with the National Restaurant Assn., the industry's dominant trade group, to create a nationwide allergy awareness program, which will launch this summer. For restaurants that choose to participate, all staff members will receive training and earn a certificate.

"We think there's a lot more education that needs to be done," says John Lehr, chief executive of FARE. He emphasizes that customers still must take precautions, but this new program addresses "the other side of that equation by getting people who are in the food service business to be more aware of food allergies."

Some restaurant owners already have taken it upon themselves to make their staff allergy-aware. Not only are these restaurants rewarded with online praise, but they also can see an increase in business. AllergyEats' Antico notes that allergic consumers are very loyal to places that accommodate them. The father of five children, including three with food allergies, Antico says: "I can make the case that the profit increase that restaurants get from being allergy-friendly is ridiculous, off the charts."

The Cheesecake Factory takes the issue very seriously, says Chief Culinary Officer Donald Moore: "For me as a chef, it's one of the scariest things that I deal with in my job, when you go out and talk to somebody with an allergy, or somebody's child or somebody's grandparent. We really want to make sure we're diligent and that our staff is well-trained."

Menus carry a warning asking guests to alert servers about food allergies. In the kitchen, precautions are taken to ensure there is no contact with allergens. According to Moore, because everything is made from scratch, chefs can inform concerned customers about the ingredients in any dish.

"We don't want our [allergic] guests to feel like they are getting less of an experience. We want it to be really seamless, just like our guests who don't have allergies, so they don't feel uncomfortable," Moore says.

After my phone interview with Moore, I headed to a nearby Cheesecake Factory for lunch. I asked the server (without identifying myself as a reporter) if my selection was safe, given my allergies. After consulting with a chef, the server said the choice was fine and that steps would be taken to prevent cross-contamination. During the meal, he even returned to make sure I was feeling OK, a first for me.

The only hiccup was when it came to dessert. There was uncertainty among the staff about whether or not guests with a peanut or tree nut allergy could safely eat any of the cheesecakes, because all of the cakes — nutty or not — were in the same display case. Whether they would make someone sick would depend on the severity of the allergy and whether there was cross-contamination.

I mention this not to criticize the Cheesecake Factory (they take more care than most restaurants, and I would eat there again) but to illustrate what the experts stress: There is no such thing as an allergy-safe restaurant, only ones that make an effort to be aware.

"Places that are responding should be commended, but I still tell patients that they can never 100% trust the server or even the chef, because accidents happen at restaurants, just like accidents happen at home," Harvard's Savage says. "Patients always need to be prepared for accidental exposures, whether it's a place they have been to a million times or not."

The nonprofit advocacy group Food Allergy Research & Education shares these tips for managing food allergies while eating out. (Go to www.foodallergy.org for additional suggestions.)

Talk to your doctor about appropriate medications, and make sure you carry them with you.

Before going out to eat, search the Internet (one popular site is www.allergyeats.com) for allergy-aware restaurants.

Call ahead and speak with a manager to determine if the restaurant can accommodate your food allergies. Find out the name of the staff member to ask for when you arrive.

At the restaurant, explain your situation to the hostess, server and manager. You can also ask to speak to the chef.

Some people carry a wallet-sized "chef card" that lists their food allergies. You can ask the server to give this to the cooks who will prepare your meal.

Avoid risky situations, such as buffets or restaurants that serve pre-made foods, because the staff may not have complete ingredient lists.